Telehealth abortions without in-person ultrasound is safe, effective

Patients who undergo medication abortion using pills delivered by mail without getting an in-person ultrasound were able to complete the procedure as safely and effectively as those who received abortion care in person, new research shows.

The study was published in the Journal of the American Medical Association on the second anniversary of the Supreme Court overturning Roe v. Wade, which ended the nationwide constitutional right to abortion. Since June 24, 2022, telehealth has played a critical role in enabling abortion access. Telehealth-enabled medication abortions typically involve virtual visits between the healthcare provider and patient, with the provider providing e-prescriptions for abortion medications like Mifepristone and Misoprostol.

Telehealth abortions made up 19 percent of all abortions in December 2023, according to data from the Society of Family Planning. The report shows that 17,000 telehealth abortions occurred per month between October and December 2023, including 930 provided by brick-and-mortar clinics, 5,800 provided under shield laws to people in states with total abortion bans or six-week abortion bans, and nearly 2,000 provided under shield laws to people in states with restrictions on telehealth abortions.

In the study, researchers from the University of California San Francisco (UCSF), Planned Parenthood of the St. Louis Region and Southwest Missouri, and Whole Woman’s Health & Whole Woman’s Health Alliance examined whether medication abortion without an in-person ultrasound is safe and as effective as in-person care.

They gathered data on 585 patients receiving abortion care from four organizations in Colorado, Illinois, Maryland, Minnesota, Virginia, and Washington between May 2021 and March 2023.

The researchers divided the patient population into three groups: the first underwent the “no-test” method, where they were assessed using a patient history-based screening without in-person ultrasound and received their medication by mail; the second underwent the “no-test” method and received their medicines in person; and the third received an ultrasound and got their medication in person. The first group included 288 patients, the second 119 patients, and the third 238 patients.

The study shows that 94.4 percent in the first group (no test plus mailed medications), 96.5 percent in the second group (no test plus in-person medication pickup), and 93.3 percent in the third group (in-person ultrasound and medication receipt) had a completed abortion, defined as abortion without the need for repeating the medication regimen or a follow-up procedure.

The rate of serious adverse events was low across the study population, at 1.1 percent. It was 1.5 percent in the first group (no test plus mailed medications) and 1.4 percent in the third group (in-person ultrasound and medication receipt). There were no serious adverse events among patients in the second group (no test plus in-person medication pickup).

“This study adds to a growing and robust body of evidence demonstrating the effectiveness and safety of medication abortion with telehealth and mailing medications,” said first author of the study Lauren J. Ralph, PhD, MPH, an associate professor of obstetrics, gynecology, and reproductive sciences at UCSF, in a news release. “Patient history-based models of medication abortion care without ultrasound and via telehealth offer a safe, effective and urgently needed way to overcome logistical and geographic obstacles to accessing abortion today.”

A previously published study also found that telehealth abortions are as effective as in-person abortion services.

Published in 2023, the literature review included 33 studies, of which 11 were qualitative, six were cross-sectional, and 13 were cohort-based. Researchers found that telehealth was an effective option for those seeking medication abortions.

Among abortion services that took place through telehealth, 6 percent or less required surgical intervention, which is comparable to in-person clinic visits.

Additionally, seven studies that focused on patient perceptions of virtual abortion services showed that more than half (56 percent) of abortion seekers preferred telehealth. They cited convenience, privacy, and cost as reasons for the preference.